Excess patient load stresses health centers

Insured patients who cannot find doctors on the Big Island are turning to community health centers, which hurts their bottom line and mission, says Hamakua Health Center's medical director.

No one is turned away, said Dr. Brian Williams, "but the more insured patients we have, the lower our reimbursements for our target population."

The state's 13 centers receive enhanced government payments for MedicareMedicaid patients, which are calculated by the percentage of those patients over the total patient population, he said.

Physicians are closing practices in Kona, and "there's really nobody in Hilo accepting patients now or in the memorable past," Williams said. The community clinics in Hilo are having trouble with staffing, and they are saturated with patients, he said.

"We actively advocate for the changes necessary so doctors can come into private practice here. We need competition so we can take care of patients who really need our services."

Williams and his wife, Gina, were traveling family practice doctors who started working at Big Island clinics and hospitals five years ago. They settled in Hamakua two years ago after Susan Hunt, Hamakua Health Center executive director, offered them jobs.

The Hamakua center sees about 5,000 patients annually at the old Hamakua Sugar Co. infirmary site and about 3,500 at the Kohala Family Health Center, which it recently took over, Williams said.

The Hamakua facility needs to expand with new clinic sites or redesign or add to the present building, he said. Most of the other community health centers are in a similar fix as they try to meet increased medical needs. As a sampling:

The 1 1/2-year-old West Hawaii Community Health Center has grown from an average of 450 patients per month to more than 900 and is still growing, said Executive Director Richard Taafe.

He said five doctors in the Kona area closed private practices in the past six to seven months, and more are closing. "We've seen an increase in private pay patients coming in because they no longer had a provider."

His center soon will have 20 people on its staff and about 25 when it opens a dental clinic next year focusing on pediatric dental care, Taafe said.

The center is working on co-locating with the Hawaiian Homesteaders Association and other service organizations for a larger facility for medical, dental, behavioral health, complimentary healing and other services, he said.

Jina Lee, who heads the 3-year-old Molokai Community Health Center, said it started with medical care and expanded with behavioral health, dental and pharmacy services. It has 17 staff members and could use more, she said.

The center is looking for a larger site or additional space to meet gaps in wellness needs, which might include more case managers, behavioral health people or social workers, she said. "It's beyond physical."

The Waikiki Health Center on Oahu also has increased demands for services at its primary care clinic, programs for the homeless, adult and youth drop-in centers and two mobile vans, said Executive Director Paul Strauss, board president of the Hawaii Primary Care Association.

He said the growth rate in the past few years has exceeded 40 percent, with patient visits nearly doubling from 8,700 per year to 15,000. The center started an integrated behavioral health program in January -- "a new development of great benefit," Strauss said.

In another major development, the center plans to purchase a fully equipped exam room mobile van with a federal grant that includes funds to support resources for homeless care, he said.

On Oahu, May Akamine, Waimanalo Health Center executive director, said she and the board are trying to rebuild the center's reputation, which suffered when a former director was sentenced for embezzling charges.

The center has about 3,250 patients per year, with about 72 percent native Hawaiians and Pacific islanders, but the number has been flat the past few years because of the facility's problems, Akamine said.

The center has a strategic plan to provide good-quality providers and training focusing on medical and behavioral health needs of patients, she said.

"I think we've been on a path of healing from what has happened in the past," she said. The facility and gardens recently were blessed "to reconfirm why we're here."